Quality Report Document Profile
IHE QRPH Profile Proposal
- Proposed Profile Name: Quality Report Document
- Proposal Date: 15 October 2008'
- Status: Proposed
- Version History: Based on quality reporting requirement in PEQD roadmap
- Editors:
{|- |Floyd Eisenberg |National Quality Forum |feisenberg@qualityforum.org |- |Others TBD |TBD |TBD |- |}
1. Brief Description of the Problem:
" Measuring quality is the first step in improving health. Regulatory and governmental organizations require the reporting of financial and clinical patient-level data for performance measurement. Some of these programs incorporate a pay-for-performance component such that healthcare organizations and clinicians are held accountable for their performance by variation in reimbursement. The current method used to obtain quality data is a labor intensive and time consuming process consisting of manual chart abstraction. To alleviate this burden and to obtain clinical information directly from data captured during the process of routine care, this proposal will incorporate mapping of data existing in clinical documents (CCD, Medical Summary, Procedure Notes) to a new HL7 DSTU, Quality Reporting Document Architecture (QRDA) to facilitate reporting with less intensive manual effort.
2. Key Use Cases
Use Case 1: Quality Reporting Use Case
Users:
Roles touched in the flow: Clinicians (Physician, Nurse, etc), Quality Management data abstractors (often nurses), Data Analysts who perform aggregation for benchmarking and performance evaluation.>
Systems:
Computer systems needing to interoperate: HIS, EHR, LIS, RIS. Primarily for the purpose of this proposal it is assumed that such interoperability exists based on locally determined architecture. The intent of the proposal is to enable the output of an EHR (i.e., a CCD or a Medical Summary, or other specific documents) to be used for quality and performance reporting. How the EHR captures those data (e.g., direct point-to-point interfaces, QED, XDS queries, etc) is not in scope for this profile.
Data:
Proposed Flow if profile implemented:
A standard measure or data request format and schema will encourage measure developers and data requesters to define with increasing precision the data required to identify the applicable cohort of patients, the interventions required and the exceptions allowed. As shown in Figure 2, the measure or data request will be available in human readable format for review and in electronic form such that local clinical information systems can consume the required data elements to perform queries using locally preferred methodologies. Identification of applicable patients can thus be performed concurrent with care to enable improved care delivery and/or early identification of adverse events based on established triggers for appropriate intervention. Retrospective reporting will also be simplified requiring a significantly smaller number of hours to allow clinician review and oversight of reporting. Transparency is critical to success and clinician acceptance. Hence, measures and patient-level data requests will be standardized and computable. Modifications to measures can also be implemented in a quicker and standardized manner with minimal effort. The white paper is to develop technical requirements to help capture appropriate information. The benefit is to enable a single effort and avoid the need to rebuild measure management at each implementation.
3. Standards that might Apply
Relevant standards: HL7 CDA, HL7 CCD, SNOMED-CT, LOINC, RxNorm, ICD-9, HL7 QRDA
4. Further Discussion
The profile is required to complete the outbound flow for quality measurement. Now that a reporting document has been successfully balloted for such use (HL7 QRDA for DSTU), the ability to use QRDA is essential. This issue has been a gap in the QRPH first year framework, PEQD, it is also a gap in fulfilling the ONC Quality Use Case and it will be picked up for use by HITSP in 2009 if completed.
5. Resources/People that could help.
From the perspective of measure developers and measure receivers, Patty Craig, The Joint Commission; Chad Bennett, Iowa Foundation for Medical Care; Rick Moore, National Committee for Quality Assurance. Individuals with CDA and XDS experience for mapping from CCD and Medical Summary to QRDA will also be required.